Social Workers Play Critical Role in Hospice and Palliative Care

March is Social Work Month

Social workers and case managers charged with placing patients into appropriate care settings often turn to hospice providers. They know that hospice services can help when a patient is not responding to curative care as hoped, when hospitalization is no longer the answer, or when the patient refuses painful and/or futile therapies.

But what does the social worker on the hospice team do? Just like hospice doctors and nurses who handle the unique and challenging issues that arise at the end of life, social workers are also key members of a patient’s hospice team.

VITAS social workers, in fact, are front-line healthcare professionals, serving as the eyes, ears, sounding board and confidantes of their patients and families. They provide guidance, resources and direct intervention when end-of-life symptoms, circumstances and diagnoses arise or change.

March is National Social Work Month, an ideal time to examine the social worker’s role in the hospice and palliative care specialties. Licensed clinical social workers are employed throughout the healthcare profession, and they can take advantage of special training in partnership with the National Hospice and Palliative Care Organization to earn special certification as a hospice and palliative care social worker. 

Social Workers: Champions for Compassionate End-of-Life Care

Social workers function as patient advocates on a hospice interdisciplinary team. They spend time with patients and families to understand underlying emotional and psychosocial dynamics and needs. They also make sure that other members of the team—doctor, nurse, chaplain, bereavement specialist and volunteer—keep the patient’s and family’s end-of-life preferences and wishes in mind in support of clinically sound, patient-centered care.

And when conventional treatments are no longer effective or curative, hospice social workers help patients and healthcare professionals navigate the emotional, psychosocial and related clinical issues that arise from a life-limiting diagnosis.

Hospice social workers:

• Understand the range of medical conditions for which hospice care is appropriate, including cancer, heart disease, Alzheimer’s/dementia, lung disease, liver and kidney failure, HIV/AIDS, ALS and other neurological diseases, trauma and more.
• Can help physicians and nurse practitioners determine when terminally ill patients are eligible for hospice care.
• Can help inform decisions about the most appropriate setting—home, hospital, skilled nursing facility, assisted living center or inpatient unit—for a patient’s hospice care, depending on the diagnosis and prognosis.
• Can identify local hospice providers and community resources that are available to patients and families.
• Address the unique needs of special patient populations at the end of life, depending on culture, beliefs, values and life experiences. Special patient populations at VITAS include military veterans; patients who identify as LGBTQ; Jewish, African American, Latino, Haitian or Asian patients; patients who speak a language other than English, and patients whose personal beliefs and preferences are shaped by their cultures or religions.
• Monitor care plans closely with the hospice team to make sure that care responds in real time to a patient’s condition, worsening/improving symptoms, caregiver capabilities and family dynamics.
• Serve as the emotional hub for meeting patient and family needs. How are the patient, the family and the hospice team coping? What are the current patient and family dynamics? What has changed for the better? What has changed for the worse? Who needs help?
• Handle many of the periphery details linked to a terminal diagnosis, including benefits and insurance forms, veteran’s issues, healthcare navigation, identification of and referrals to community resources (e.g., homemaking services, Meals on Wheels, food assistance), clergy communication, funeral arrangements, memorial services, family travel and more.

Facilitators for End-of-Life Conversations

A sensitive topic that hospice social workers face with patients and families is the end-of-life conversation, including advance directives and living wills. They often help patients and families talk about, document and agree to goals of care shaped by their wishes and preferences for end-of-life care—conversations that may be impeded by conflicting opinions or diverging values among patients and families about the best course of action.

Based on an early initiative from the VITAS San Antonio program, social workers are undergoing specialized training and certification as facilitators of advance care planning discussions. They work as a conduit between physicians, patients and families to ensure that frank and honest discussions are held about sensitive but necessary topics, from do-not-resuscitate orders, feeding tubes and medications to decisions about burial vs. cremation, or religious funeral vs. non-religious memorial service.

National Social Work Month is the ideal time to recognize the multiple roles, responsibilities and duties that social workers carry out for hospice patients, families and healthcare professionals.